Healthcare Provider Details

I. General information

NPI: 1366372476
Provider Name (Legal Business Name): EMILY GORDON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N VINEYARD BLVD STE A325
HONOLULU HI
96817-3938
US

IV. Provider business mailing address

2028 SEAMOUNT ST UNIT 1
OCEAN ISLE BEACH NC
28469-0658
US

V. Phone/Fax

Practice location:
  • Phone: 773-888-3312
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-5522
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: